Diagnosis of Left Ventricular Diastolic Dysfunction on Resting Ecg – A Prospective Study

Abstract

Background: Heart failure due to preserved as well as reduced ejection fraction is a major healthcare challenge; echocardiography, including tissue Doppler Imaging (TDI) serves as the cornerstone of its diagnosis. ECG is a widely available,relatively inexpensive tool for predicting left ventricular diastolic dysfunction (LVDD). Objectives:We aimed to study different parameters in resting 12-lead ECG to evaluate whether they can predict LVDD diagnosed on detailed echocardiography including TDI. Methods: This was a cross-sectional study of 39 patients undergoing echocardiographic study in cardiology department of our institute.They were classified into two groups based on LVDD (Group 1 Normal, Group 2 LVDD) and their resting 12-lead ECG was analyzed for following parameters: QT interval, corrected QT interval, P wave duration (PW-D) and height (PW-H) in Lead 2, P terminal wave duration (P term-D) and height ( P term-H) in lead V1, P wave terminal force in lead V1.Correlation of these parameters with LVDD was investigated. Results: Study included 39 patients,females 16,males 23,with age range 20-87 (mean 48) years.Group 1 comprised of 14 normal echo patients and 25 patients with LVDD were in Group 2. The Mean QTc was 419ms (SD 21) and 440ms (SD 30) in Group 1 and Group 2 respectively, which was statistically significant (p =0.03). The P terminal wave duration V1 difference was statistically significant (p 0.03) with a mean of 39±17 ms vs 52±19 ms in Grp 1 and Grp 2 respectively. P terminal wave height V1 was 0.79±0.26 mm in Grp 1 and 1.1±0.41 mm in Grp 2, which was statistically significant (p= 0.01). Morris Index was statistically highly significant between the two groups (0.03±0.02 mm.s Grp1 and 0.07±0.04 mm.s in Grp2,p 0.009).P wave height lead 2 was 1.1±0.4 mm and 1.7±0.6 mm in Grp 1 and Grp 2 respectively (p= 0.002). P wave duration in Lead 2 did not find significance statistically (p 0.08) with mean 90±19 ms versus 103±26ms in Group 1 and 2 respectively. Conclusion: QTc, P terminal wave duration and amplitude in V1, Morris Index, and P wave amplitude in lead 2 are significantly higher in patients with echocardiographic diagnosis of LVDD.